MEDICARE: DR. SPENCER E JOHNSON DDS MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	78439839921	UT

General Provider Information

NPI Number	:	1841427846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SPENCER E JOHNSON DDS MS

Provider Business Mailing Address
First Line	:	2453 E 3300 S STE 201
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2725
Country	:	US
Telephone Number	:	801-466-0040
Fax Number	:	801-463-0481

Provider Business Practice Location Address
First Line	:	2453 E 3300 S STE 201
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2725
Country	:	US
Telephone Number	:	801-466-0040
Fax Number	:	801-463-0481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	06/15/2026

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